Medihelp Complaint
 SUPPLIER |
Medihelp |
 INDUSTRY |
Medical Aid |
| BRANCH / AREA | customer service | COUNTRY | South Africa |
| TIME / DATE | 15:12 Wed 11 Jan | PERSON RESPONSIBLE | |
| CUSTOMER | Fibrahunt | View all reports by user |
 0
3
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| PROBLEM | Billing / Accounts |
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| INCIDENT | Wed 11 Jan | ||
| HEADLINE | NOT PAYING CLAIMS |
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I had sent a medical claim to the value of R650. Which i still haven't received... I gave your call centre today regarding this, they explained to me that I don't get full benefit and that the reason why they didn't pay my medical fee. Why wasn't pro-rata explained when signing up(I ONLY FOUND THIS OUT NOW WHEN ON THE PHONE, WHEN REFUSING TO PAY CLAIMS)? Why wasn't this in the contract I signed? I paid for something I only got half benefits for, Where I thought I was getting full benefits paying the full montly fee you had been cheating me by giving me half. I was sold a contract on a base of ****. If I had to do this to you, I would have had your lawyers all over me. If you want I will send you the contract I signed with a smile. NO PRO-RATA mentioned |
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| SUPPLIER'S RESPONSE | Medihelp | Time and Date | 15:23:16 | Wed 11 Jan 12 |
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Hello Fibrahunt, Thank you for writing to us. Your complaint was referred to our client service department for investigation and a consultant will contact you in this regard. Kind regards Medihelp Customer Care |
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| UPDATED RESPONSE | Medihelp | Time and Date | 15:29:30 | Mon 23 Jan 12 |
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Hello Fibrahunt, With regards to your complaint in respect of pro-rata benefits, I wish to emphasise that Medihelp did inform you of the pro-rata benefits that will be applicable on your membership as per your conditions of membership stipulated under the heading important information. Regulation 9 of the Regulations promulgated in terms of the Medical Schemes Act, 1998 (Act 131 of 1998) further stipulates that a medical scheme may, in respect of the financial year in which a member joins the scheme, reduce the annual benefits with the exception of the prescribed minimum benefits, pro-rata to the period of membership in the financial year concerned. Therefore, the account in respect of Dr Potze and partners for services rendered on 28 November 2011 remains your responsibility, as the calculation in respect of your pro-rata benefits was correctly applied by the Scheme on your membership application. Kind regards Medihelp Customer Care |
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